Comparison of effects of general anesthesia versus combined epidural-general anesthesia on postoperative complications in patients undergoing thoracic surgery

Abstract

Objective To compare the effects of general anesthesia versus combined epidural-general anesthesia on postoperative complications in the patients undergoing thoracic surgery. Methods Two hundred twenty-one patients of both sexes, aged 18-80 yr, weighing 36-100 kg, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective thoracic surgery, were randomly divided into either combined epidural-general anesthesia group(group GE, n=112)or general anesthesia group(group GA, n=109). The patients were further allocated to high-risk population and low-risk population.Anesthesia was induced with target-controlled infusion of remifentanil and iv injection of propofol, sufentanil and rocuronium.A double-lumen endotracheal tube was placed, and the patients were mechanically ventilated.Partial pressure of end-tidal CO2 was maintained at 30-40 mmHg.Anesthesia was maintained with inhalation of 1% sevoflurane, target-controlled infusion of remifentanil, iv infusion of propofol, and intermittent iv boluses of sufentanil.2% lidocaine 4 ml/h was infused epidurally in group GE, and normal saline 4 ml/h was given in group GA.Bispectral index value was maintained at 40-60 during surgery.Patient-controlled epidural analgesia(PCEA)was performed after surgery.PCEA solution contained 0.125% ropivacaine and sufentanil 0.5 μg/ml(in 250 ml of normal saline). The PCEA pump was set up to deliver a 2 ml bolus dose with a 20-min lockout interval and background infusion at 4 ml/h, and visual analogue scale(VAS)score was maintained less than 4.When VAS score ≥ 5, sufentanil 5 μg was injected intravenously as the rescue analgesic.The requirement for rescue analgesics after surgery, length of hospital stay after surgery, complications during postsurgical hospital stay(cardiovascular events, cardiac insufficiency, acute coronary syndrome, pulmonary infection, stroke, transient cerebral ischemic attack), and death within 30 days after surgery were recorded. Results Compared with group GE, the incidence of postsurgical cardiovascular events and atrial fibrillation was significantly decreased in group GA(P 0.05). Conclusion Compared with combined epidural-general anesthesia, general anesthesia alone provides lower occurrence of postsurgical complications for the patients undergoing thoracic surgery, and offers advantage for the high-risk patients having underlying diseases before surgery. Key words: Anesthesia, general; Anesthesia, epidural; Postoperative complications; Thoracic surgical procedures